The Value of Laparoscopy in Management of Penetrating Rectal Injuries

The basic tenet in management of penetrating rectal injuries is diversion of feces after other injuries are excluded. Laparoscopy may offer expeditious work-up and diversion all in one setting with comparable safety and benefits of a minimally invasive approach. To support this hypothesis, we reviewed all patients with suspected rectal injuries in last 2 years.Method: Patients with suspected rectal injuries underwent CT with contrast followed by sigmoidoscopy and laparoscopy. When no associated injuries were found, diversion was effected by sigmoid loop colostomy modified for complete diversion. Presacral drainage and distal rectal wash out were not done. Length of stay, missed injury, complications were collected and compared with that of patients treated by traditional laparotomy. Statistical analysis was performed using t-test.Results: Of the 16 stable patients with penetrating extraperitoneal rectal injuries, 4 patients were treated using the protocol defined above. All injuries were demonstrated by sigmoidoscopy.Conclusion: Isolated extraperitoneal rectal injuries in urban trauma can be safely treated with laparoscopic exclusion of intraperitoneal injuries followed by laparoscopic assisted diversion, without presacral drainage or distal fecal washout. Benefits are reliability in ruling out intraperitoneal injury, early bowel function return, low complication rate and a statistically significant reduction in LOS